Provider Demographics
NPI:1982628806
Name:JIRANEK, GEOFFREY CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:CHARLES
Last Name:JIRANEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 9TH AVE
Mailing Address - Street 2:MS M4-PA
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-515-5811
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-223-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024350207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAUS0899649OtherAETNA/USHC SPECIALIST
WA1982628806OtherMONTANA MEDICAID
WAUS0818917OtherAETNA/USHC PCP
WA805167700OtherIDAHO MEDICAID
WA8120032Medicaid
WAJI9861OtherBLUE SHIELD
WAMD5024OtherALASKA MEDICAID
WA0039580OtherLABOR & INDUSTRY
100006268OtherRAILROAD MEDICARE
WA8851235Medicare PIN
WA805167700OtherIDAHO MEDICAID
WA000181771Medicare PIN